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Abstract
Objective: To explore clinical phenotype and characteristics of Parkinson disease (PD) at different ages at onset in recently diagnosed patients with untreated PD.
Methods: We have analyzed baseline data from the Parkinson's Progression Markers Initiative database. Four hundred twenty-two patients with a diagnosis of PD confirmed by DaTSCAN imaging were divided into 4 groups according to age at onset (onset younger than 50 years, 50–59 years, 60–69 years, and 70 years or older) and investigated for differences in side, type and localization of symptoms, occurrence/severity of motor and nonmotor features, nigrostriatal function, and CSF biomarkers.
Results: Older age at onset was associated with a more severe motor and nonmotor phenotype, a greater dopaminergic dysfunction on DaTSCAN, and reduction of CSF α-synuclein and total tau. The most common presentation was the combination of 2 or 3 motor symptoms (bradykinesia, resting tremor, and rigidity) with rigidity being more common in the young-onset group. In about 80% of the patients with localized onset, the arm was the most affected part of the body, with no difference across subgroups.
Conclusions: Although the presentation of PD symptoms is similar across age subgroups, the severity of motor and nonmotor features, the impairment of striatal binding, and the levels of CSF biomarkers increase with age at onset. The variability of imaging and nonimaging biomarkers in patients with PD at different ages could hamper the results of future clinical trials.
GLOSSARY
- Aβ1–42=
- β-amyloid 1–42;
- α-syn=
- α-synuclein;
- HC=
- healthy control;
- HVLT=
- Hopkins Verbal Learning Test;
- H&Y=
- Hoehn and Yahr;
- MDS-UPDRS=
- Movement Disorder Society–Unified Parkinson's Disease Rating Scale;
- MoCA=
- Montreal Cognitive Assessment;
- PD=
- Parkinson disease;
- PPMI=
- Parkinson's Progression Markers Initiative;
- p-tau181=
- tau phosphorylated at Thr181;
- SCOPA-AUT=
- Scales for Outcomes in Parkinson's Disease–Autonomic;
- STAI=
- State-Trait Anxiety Inventory;
- t-tau=
- total tau;
- UPSIT=
- University of Pennsylvania Smell Identification Test
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received August 9, 2015.
- Accepted in final form November 25, 2015.
- © 2016 American Academy of Neurology
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